At least twice a week in his medical office in Beverly Hills, David Agus will sit in front of a patient, look them in the eye and say, "I have no more drugs to treat your cancer."
Agus, one of America's preeminent cancer specialists and a man who has spent decades on the front lines of cancer research, dreads these moments. He is frustrated by the depressing reality that for most of the cancer patients he treats today, the prospects of surviving some major cancers are not very different than they were 50 years ago.
"We have little wins that we've made here," Agus told the Irish Independent over the phone from his office in California, "but the big cancers – the lung cancer, the colon cancer, the breast cancer, the prostate – we haven't made that much of a dent in. And it's embarrassing."
So Agus, a physician whose famous patients have included billionaire Apple founder, the late Steve Jobs, has decided to change the rules of the game: by focusing not just on the treatment of cancer but on its prevention too. That means encouraging us all to make simple adjustments in the way that we live.
"To me cancer is a verb, not a noun," Agus says. "You don't 'get' cancer. You don't 'have' cancer. You're 'cancering'."
"My job – and it took me a long time to understand this – is not to shrink your cancer but to change your health state to help you live longer and better."
In a new book, A Short Guide to a Long Life, Agus lays out 65 rules that he believes will extend our lifespan and protect us from the advance of chronic disease. All of his rules are simple, sensible and – he is keen to point out – grounded in empirical data.
They range from smiling more to getting a flu shot to ditching your high heels and taking your blood pressure on a more regular basis. Agus admits that he doesn't expect everyone to follow all 65 rules but says that by taking a pragmatic approach to our health we can avoid chronic ailments like heart disease, diabetes and dementia.
Some of the rules I love – such as adopting a sensible caffeine diet (18), drinking a glass of wine at din ner (10), pursuing your passions (30) and getting off your backside more (16). Others seem a little quirky but intriguing – getting naked in front of a mirror (15), taking a baby Aspirin every day (22), avoiding airport back scanners (56), growing a garden (7), and picking up a pooch (49).
Some of Agus's rules have no relation to my life as a mother/wife/writer/consult- ant/domestic goddess – Agus's Rule Number 63 to get more "downtime" made me laugh out loud. Another, Rule 47 – to have children – I am convinced is already putting me into an early grave.
Agus really gets my attention when he mentions Rule Number 3 – to automate your life and keep a regular eating and sleeping schedule – something I rarely do owing to the frenetic demands of my life. I guiltily admit to Agus that I frequently break Rule Number 41 – never skip breakfast.
"The biggest marker of stress on the body is schedule. So it's not just what you eat, it's when you eat. It's not just how you sleep, it's when you sleep," he says. "That regularity really has a dramatic influence. People who graze have an 81pc more diabetes when you control for weight."
So at 41 years of age, should I really take a baby Aspirin or statin before I go to bed? And do I really need to ditch those high heels?
See David Agus' TED talk video here - David Agus: A new strategy in the war on cancer
"I really don't envision anybody doing all of the rules but what I envision is you being in charge of you," says Agus, who encourages readers to take a copy of his book of rules to their doctor so they can discuss the implications together. "The book really isn't telling you to take an Aspirin. It's telling you to have the conversation with your doctor."
But even Agus' wife – Hollywood actress Amy Povich – has given him some flak over Rule Number 59, to avoid stilettos.
"I'm not against high heels. I'm against shoes that hurt you at the end of the day. You have to make aggressive statements like this for people to realise that inflammation is bad," he says, somewhat defensively.
Agus's philosophy has garnered huge attention in America, where he is a New York Times best-selling "pop doc" and somewhat controversial. Although Agus can count rock stars, billionaires and Hollywood legends on his patient list, he is most famous for his relationship with Steve Jobs, an icon he refers to liberally in the course of our conversation.
"I have patients, some of whom are remarkable, and who live until the day they die", Agus says. "Steve Jobs was talking to his family and friends the morning of the day he died.
"Steve never once said to me, 'Why me?' He just said, 'Let's fight this. Let's use every technology to understand the cancer and let's put all of my data in the public domain,'" Agus says in reference to the Apple chief's decision to have the DNA of his cancer sequenced. "He wanted other people to benefit too."
Agus is not afraid to practise what he preaches. He conducts our interview by walking around his office wearing a headset (16) and every Sunday plans the weekly dinner menu with his wife and two teenage kids and then shops for food at the local farmers' market (Rule 5 – eat real food).
And he understands that in the US, just like in Ireland, prevention can be a hard sell. "How do you get somebody to care about something that will happen decades from now?" he asks. "How do you get a kid in their twenties to make a change that will affect them in their 50s, 60s or 70s?"
But for a man who has spent a lifetime on the frontlines of cancer, watching so many patients lose their lives in a painful and distressing way, Agus has a simple message: to act now, take stock of your health and think about the future.
"I'd like nothing more than to be put out of my job," he says.
'A SHORT GUIDE TO A LONG LIFE' BY DAVID B AGUS, SIMON & SCHUSTER, IS OUT NOW